This patient, a 57-year-old female with end stage renal disease and multiple comorbidities, was admitted with abdominal pain and fever and found to have a large liver abscess. Over several weeks of management including percutaneous drainage and stenting, her condition deteriorated with persistent sepsis until she suffered cardiac arrest and passed away. Her complex medical history and ongoing infection proved too much for her body to overcome despite multidisciplinary treatment efforts.
Liver Transplantation for Hepatic Trauma: Case Report and Literature Reviewsemualkaira
Liver transplantation can be offered to selected
patients following sever liver trauma as a possible life-saving procedure after all other treatment modalities have been exhausted.
Authors present a case of severe liver trauma followed by liver
transplantation due to total liver necrosis as a result of initial damage-control surgery and embolisation with literature review
Introduction: Endoscopic RetrogradeCholangiopancreatography (ERCP) has been advocated as a less invasive therapeutic
intervention for the diagnosis and management of various pancreaticobiliary diseases in the aging population. However, the procedure is not without risk. Published literatures have shown different adverse outcomes with the oldest patient documented to be at 97-years-old. This case report of a 99 years and 107 days old male is probably one of the oldest to be recorded to undergo ERCP worldwide, hence is a vital addition to current practice.
Managament of anastomotic leak - case capsule- Dr Keyur BhattDrKeyurBhattMSMRCSEd
Management of anastomotic leak after gastrointestinal surgery. This is very important step for any general or GI surgeons to know how to deal with the anastomotic leak following surgery.
Liver Transplantation for Hepatic Trauma: Case Report and Literature Reviewsemualkaira
Liver transplantation can be offered to selected
patients following sever liver trauma as a possible life-saving procedure after all other treatment modalities have been exhausted.
Authors present a case of severe liver trauma followed by liver
transplantation due to total liver necrosis as a result of initial damage-control surgery and embolisation with literature review
Introduction: Endoscopic RetrogradeCholangiopancreatography (ERCP) has been advocated as a less invasive therapeutic
intervention for the diagnosis and management of various pancreaticobiliary diseases in the aging population. However, the procedure is not without risk. Published literatures have shown different adverse outcomes with the oldest patient documented to be at 97-years-old. This case report of a 99 years and 107 days old male is probably one of the oldest to be recorded to undergo ERCP worldwide, hence is a vital addition to current practice.
Managament of anastomotic leak - case capsule- Dr Keyur BhattDrKeyurBhattMSMRCSEd
Management of anastomotic leak after gastrointestinal surgery. This is very important step for any general or GI surgeons to know how to deal with the anastomotic leak following surgery.
The Importance of Identifying Sepsis in the Golden First HourHasan Arafat
A case of a patient who was missed while in early sepsis. It sheds light on the importance of sticking to the guidelines of management of sepsis and how it can protect patients from deteriorating.
Case Study University Hospital Discharge Summary Medical Record -# 12-.pdfaonetelecompune
Case Study University Hospital Discharge Summary Medical Record \# 12-34-56 Patient Names
Willam Edison Admitted: 11/1/19 Discharged: 11/12/19 Chief Complaintt This 66 y.o. male was
admitted for nausea, vomiting and anorexia of three days duration. The patient also complained
of recent RUQ pain and pyrosis after heavy meals. This is the second hospital admission for this
66 y.0. male patient with a known history of chronic kidney disease, hypertension, osteoarthritis,
asthma, gastroesophogeal reflux disease, PUD (with prior hemorrhage), and bilateral total knee
replacement. Prior to admission, the patient had been drinking heavily as he had in the past and
he had tremors prior to admission. He sleeps on two pillows and has dyspnea after climbing one
flight of stairs. He denied recent colds, upper respiratory infections, hematemesis or diarrhea.
The patient complained of some urinary frequency and urgency. There was a rash noted on the
forearms, which the patient had been treating with Benadryl cream. Physical Examination: The
patient was in some distress on examination. Examination of the head revealed pupils and eye
movements to be within normal limits. The chest was clear and the heart rate was normal. The
blood pressure was elevated at 200/120 . Temperature was slightly elevated at 100.6. Pulse was
72 and respirations vere 16. Examination of the abdomen revealed some distention with pain in
the RUQ. The rectal examination revealed an enlarged prostate of two to three times the normal
size. Occult blood was negative. The rest of the exam was within normal limits. Laboratory
Studies: Admission blood tests revealed an elevated white blood cell count as well as an elevated
serum bilirubin. Urinalysis showed albuminuria, the presence of bacteria, TNTC white cells and
pus. Sonography and HIDA scan revealed cholelithiasis. PSA was 19.8. Impression:
Cholelithiasis/cholecystitis. Enlarged prostate with elevated PSA, possible BPH, rule out tumor.
Consider EGD due to history of GERD and PUD. Hospital Courser The patient was diagnosed
with cholelithiasis/cholecystitis. The patient underwent laparoscopic cholecystectomy under
general endotracheal anesthesia. Pathology revealed chronic cholecystitis and cholelithiasis. The
patient tolerated the procedure well. On postop day 22 the patient developed nausea and
vomiting which was likely due to a postoperative paralytic ileus. The patient was treated
conservatively with a nasogastric tube to low concomitant suction. During the hospitalization,
the patient also underwent transrectal vitrasound of the prostate with biopsy. Operative report
revealed that the seminal vesicles were not dilated and the prostatic capsule was intact. Biopsy
results were positive for adenocarcinoma of the prostate. Patient to be scheduled for TURP on
another admission. The patient was treated with IV Levaquin for UT. The patient's ilens resolved
and he was discharged on postop day 35 with plans for outpatient follow-up. The patient.
Portal hypertensive biliopathy management - case based learning -Dr Keyur BhattDrKeyurBhattMSMRCSEd
Portal hypertensive biliopathy is a very rare and deadly situation if not managed properly. A team of Gastrosurgeon, Gastro physicians, and Interventional radiologists should be involved before making any decision in this kind of cases.
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: Augu...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
- Nephrolithiasis
- Infected Iliac Aneurysm
- Pancreatic Masses
Palliative Care and Acute Oncology IntegrationRecoveryPackage
Dr Catherine O'Doherty, Consultant in Palliative Medicine, Trust Acute Oncology Lead and Lead Cancer Clinician, Basildon and Thurrock University Hospitals NHS Foundation Trust
Karen Andrews, Head of Nursing for Macmillan/Acute Oncology and EOL services, Basildon and Thurrock University Hospitals NHS Foundation Trust
The Importance of Identifying Sepsis in the Golden First HourHasan Arafat
A case of a patient who was missed while in early sepsis. It sheds light on the importance of sticking to the guidelines of management of sepsis and how it can protect patients from deteriorating.
Case Study University Hospital Discharge Summary Medical Record -# 12-.pdfaonetelecompune
Case Study University Hospital Discharge Summary Medical Record \# 12-34-56 Patient Names
Willam Edison Admitted: 11/1/19 Discharged: 11/12/19 Chief Complaintt This 66 y.o. male was
admitted for nausea, vomiting and anorexia of three days duration. The patient also complained
of recent RUQ pain and pyrosis after heavy meals. This is the second hospital admission for this
66 y.0. male patient with a known history of chronic kidney disease, hypertension, osteoarthritis,
asthma, gastroesophogeal reflux disease, PUD (with prior hemorrhage), and bilateral total knee
replacement. Prior to admission, the patient had been drinking heavily as he had in the past and
he had tremors prior to admission. He sleeps on two pillows and has dyspnea after climbing one
flight of stairs. He denied recent colds, upper respiratory infections, hematemesis or diarrhea.
The patient complained of some urinary frequency and urgency. There was a rash noted on the
forearms, which the patient had been treating with Benadryl cream. Physical Examination: The
patient was in some distress on examination. Examination of the head revealed pupils and eye
movements to be within normal limits. The chest was clear and the heart rate was normal. The
blood pressure was elevated at 200/120 . Temperature was slightly elevated at 100.6. Pulse was
72 and respirations vere 16. Examination of the abdomen revealed some distention with pain in
the RUQ. The rectal examination revealed an enlarged prostate of two to three times the normal
size. Occult blood was negative. The rest of the exam was within normal limits. Laboratory
Studies: Admission blood tests revealed an elevated white blood cell count as well as an elevated
serum bilirubin. Urinalysis showed albuminuria, the presence of bacteria, TNTC white cells and
pus. Sonography and HIDA scan revealed cholelithiasis. PSA was 19.8. Impression:
Cholelithiasis/cholecystitis. Enlarged prostate with elevated PSA, possible BPH, rule out tumor.
Consider EGD due to history of GERD and PUD. Hospital Courser The patient was diagnosed
with cholelithiasis/cholecystitis. The patient underwent laparoscopic cholecystectomy under
general endotracheal anesthesia. Pathology revealed chronic cholecystitis and cholelithiasis. The
patient tolerated the procedure well. On postop day 22 the patient developed nausea and
vomiting which was likely due to a postoperative paralytic ileus. The patient was treated
conservatively with a nasogastric tube to low concomitant suction. During the hospitalization,
the patient also underwent transrectal vitrasound of the prostate with biopsy. Operative report
revealed that the seminal vesicles were not dilated and the prostatic capsule was intact. Biopsy
results were positive for adenocarcinoma of the prostate. Patient to be scheduled for TURP on
another admission. The patient was treated with IV Levaquin for UT. The patient's ilens resolved
and he was discharged on postop day 35 with plans for outpatient follow-up. The patient.
Portal hypertensive biliopathy management - case based learning -Dr Keyur BhattDrKeyurBhattMSMRCSEd
Portal hypertensive biliopathy is a very rare and deadly situation if not managed properly. A team of Gastrosurgeon, Gastro physicians, and Interventional radiologists should be involved before making any decision in this kind of cases.
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: Augu...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
- Nephrolithiasis
- Infected Iliac Aneurysm
- Pancreatic Masses
Palliative Care and Acute Oncology IntegrationRecoveryPackage
Dr Catherine O'Doherty, Consultant in Palliative Medicine, Trust Acute Oncology Lead and Lead Cancer Clinician, Basildon and Thurrock University Hospitals NHS Foundation Trust
Karen Andrews, Head of Nursing for Macmillan/Acute Oncology and EOL services, Basildon and Thurrock University Hospitals NHS Foundation Trust
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
2. Agenda
• Patient’s Data & Case Summary.
• Clinical course and events.
• Evidence Based Reviews in Surgery
3. Patient’s Data
&
Case Summary.
Admission Date 28/10/2023. Hour 8:02 pm
Date of expiry 23/11/2023. Hour 10.36 pm
Total span of the patient's hospital stay 27 days
57 yrs. female admitted through ER with chief
complaints,
Pain abdomen (Epigastric tenderness)
Repeated vomiting
Fever
The patient was initially admitted through an
emergency in Female Medical Ward D7 since
she was known case of ESRD on haemodialysis
on every alternated day.
She had a history of repeated admissions to
nephrology ward for HD.
4. Patient’s Data
&
Case Summary.
Signifinfant Comorbidities
• HTN,DM,CKD on HD + CKD-MBD due renal
hyperparathyroidism
• Persistant Iron Defeciency Anemia due to ESRD
• AVF for HD on right arm.
• Past Surgical Hx Lap Chole + LSG and right kidney
surgically removed (CAT-CT scanning proven.)
• Left side diabetic foot small ulcer at foot dorsum
(PVD likely).
• The patient also had past Hx of CVA with mild
hemiparesis and The patient had difficulty walking
and was almost bedbound.
5. Clinical course
&
events.
SINCE this patient was under the care of a
multidisciplinary team we will highlight the
important events in more details.
Date 28-10-23 to 31-10-23
After Admission in ward 7 nephrology department
following management steps were taken out.
Prompt arrangement of Haemodialysis as a
routine session.
Referral to DF and wound care (debridement +
tissue c/s )
Gastroenterology was consulted, Endoscopy
done shows post sleeve pan erosive Gastritis,
duodenitis, esophagitis GERD Grade A.
6. Clinical course
&
events.
Date 28-10-23 to 31-10-23
We General Surgery were consulted for
Pain Epigastrium.
CT Abdomen and pelvic shows 7x7x4 cm
left lobe segment 4 likely liver abscess.
7. Clinical course
&
events.
Date 28-10-23 to 31-10-23
• Intervention Radiologist consulted for USG
guided Pig tail insertion initially 15ml thick
pus aspirated and then more 10 ml take for
c/s.
• After some time, during the ward round, up
to 100 milligrams were recorded showing
successful intervention,
• However, the quantity markedly decrease
in next 5 days and the last ready just 10 ml
/24 hours.
8. Clinical course
&
events.
Date 31-10-2023 to 05-11-2023
Intervention Radiologist is contacted for up-sizing the
pigtail from 8.00 FR to 10 FR and advised flushing with
saline daily.
Date 05-11-2023 to 11-11-2023
Reapeat CT abdomen shows progressive cousre with
sustained loculies 6.2x11x6 cm within sigment 4 and 3.
However, the pigtail was in situ within the anterior loculus
3.5x2x5.5 cm.
So,2nd Pig tail is inserted
9. Clinical course
&
events.
Date 11-11-2023 to 20-11-2023
• Both the drains were well functional but the discharge
was increasing day by day and the colour was greenish
yellowish biliary type.
• It raised the suspicion of intrahepatic biliary fistula due
to persistent hepatic locules in the follow-up ultrasound
abdomen.
• Gastro informed for ERCP But they suggested to
involve HB Dept.
• HB dept. Suggest for ERCP and CBD stenting.
• Gastro did ERCPS,P/O ERCP patient was kept in
SICU then shifted back surgical ward D-9 and was
under care of Unit-B2.
• Haemodialysis was continued daily or every other day
as needed.
ERCP FINDINGS:
ERCP done
CD cannulation done
CBD cholangiogram showed mildly dilated BD,
possible intrahepatic biliary leakage
sphincterotomy done
CBD stent 7 fr, 7 cm inserted with good biliary
drainage
10. Clinical course
&
events.
Date 20-11-2023
• Post ERCP Patient labs parameter coming
toward normal level.
• Abdomen soft and lax.
• Orally taking food wel tolerated.
• Vitally stable BP 120/80 HR-86 BPM.
• Over all patient shows transient good
outcome.
• But pigtail drainage shows still persistant
high out put e.g 1/2-180/nill ml then 4ml/38
ml.
Labs
WBC-12.9
HB-8.2
Platelets-229
Amylase-104
Lipase-160
Creatinine-428
11. Patient’s Data
&
Case Summary.
Date 21-11-2023
Unfortunately this morning our patient had a severe
epileptic seizure/TCS
Probably due to ESRD-MBD
• CA-1.95 (2.2-2.65)
• PHOSPHORUS-1.48 (0.78-1.58)
Attended by Nephro on call
Tab Caltrate p/o TDS
Ct brain virtual venography requested
Inj Rocephin
HD on next day
Blood transfusion
Surgical intervention to remove septic focus
Repeat lab CBC and ADM. Prof
Vancomycin trough
12. Patient’s Data
&
Case Summary.
• Date 21-11-2023 Evening round
• S/B Surgeon on-call
• Quite stable,doing well ,Having no active
issue
• BP-120/80 Pulse-86bpm afibrile 37 C
• He was seen by Gastro as well and there
was nothing needed to do
• (CST-------TFO)
LABS
Wbc 12.7()
HB-8
LIPASE 102 (160)
AMYLASE 38 (104)
13. Clinical course
&
events.
• Date 22-11-2023 Morning Round
• Dialysis was going on during the morning
round but the patient's condition was not
looking good.
• The patient was drowsy, unable to respond
to verbal commands.
• S/B Neurology on call her recent
complains Fits-GTC (4 days ago she had
Fits-GTCS during HD and she stayed in
ICUS for one day.)
• tablet valproic acid (Depakin 500 mg)
• F/UP in OPD
15. Patient’s Data
&
Case Summary.
Date 22-11-2023 Evening SICU shifting
The patient's condition deteriorated all of a
sudden in ward D-9.
SICU informed and patient is S/B SICU on call
GCS E3+V3+M bed bound
BP-70/43
PULSE-105 BPM
SPO2-96% +8 Lit O2
Inj-Levophed 10mg/hour
Patient is shited to SICU
Some radiological work up in sicu (USB,PAN
CT)
16. SICU
Clinical course
&
events.
Date 23-11-2023 SICU Managements details
• During the SICU stay we actively followed the patient
and were in close contact with MDT colleagues.
• Cardiologist consulted for suspicion septic
cardiomyopathy and echo findings (Bil.Vent sluggish
contraction EF-50%,RV dilatation with global
hypokinesia, advise to rule out PE.
• Hepitico-biliary team again informed but they denied
from surgical intervention.
• IR Informed to do bedside USG as we had suspicion
of biliary peritonitis or to assess the current pigtail
functionality.
• IR did usg abd, no residual peritoneal collection and
both the pigtails are in situ in the right position
17. SICU
Clinical course
&
events.
• Date 23-11-2023 SICU Managements details
on 23/11/2023 due to severe tachycardia & severe
hypotension, intubated to mechanical ventilation.
Inotropic & Fluid Resuscitation started.
Reviewed by cardiologist as she has septic cardiomyopathy.
Patient was reviewed by surgeon who asked to do pan CT to
rule out Pulmonary embolism or bowel ischemia, report came
with stationary coarse, no significant issues.
patient has severe metabolic acidosis with very high Lactate
level more than 15.
So CRRT was started for 24 hrs without UF but patient
condition deteriorated so CRRT was held.
The condition of the patient was continuously deteriorating and
inotropic requirements were increasing.
On 23/11/2023, pt developed cardiac arrest, CPR was done as
per ACLS protocol but with no response.
Medications during stay: COLISTIN, MERONAM,
VANCOMYCIN, AMIKACIN, ECALTA, LOSEC, KEPPRA.
ALBUMIN, DOBUTAMINE, LEVOPHED &VASOPRESSIN
Death was declared at 10:36 PM.
18.
19.
20. Evidence Based Reviews in Surgery
regarding
Liver abscess in ESRD+HD
• An untreated hepatic abscess is nearly uniformly fatal as a
result of complications that include sepsis, empyema, or
peritonitis from rupture into the pleural or peritoneal spaces, and
retroperitoneal extension. Treatment should include drainage,
either percutaneous or surgical.
• Shock with multisystem organ failure is a contraindication for
surgery.
Open surgery can be performed by either of the following two approaches:
1:-A transperitoneal approach.
2:-For high posterior lesions, a posterior trans pleural approach can be used.
3:-A laparoscopic approach.
In selected pt.
Minimally invasive
Reduce morbidity
4:Interventional Radiologist/PCD
(Size > 5cm)
Morbidity was comparable for the two procedures (LAP vs PCD)
But those treated with surgery had fewer secondary procedures and fewer treatment
failures